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  • 1
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    Cardiovascular Disease, Cancer, and Mortality Among People With Type 2 Diabetes and Alcoholic or Nonalcoholic Fatty Liver Disease Hospital Admission
    American Diabetes Association ; 2018
    In:  Diabetes Care Vol. 41, No. 2 ( 2018-02-01), p. 341-347
    Details
    In: Diabetes Care, American Diabetes Association, Vol. 41, No. 2 ( 2018-02-01), p. 341-347
    Abstract: To describe associations between alcoholic liver disease (ALD) or nonalcoholic fatty liver disease (NAFLD) hospital admission and cardiovascular disease (CVD), cancer, and mortality in people with type 2 diabetes mellitus (T2DM). RESEARCH DESIGN AND METHODS We performed a retrospective cohort study by using linked population-based routine data from diabetes registry, hospital, cancer, and death records for people aged 40–89 years diagnosed with T2DM in Scotland between 2004 and 2013 who had one or more hospital admission records. Liver disease and outcomes were identified by using ICD-9 and ICD-10 codes. We estimated hazard ratios (HRs) from Cox proportional hazards regression models, adjusting for key risk factors. RESULTS A total of 134,368 people with T2DM (1,707 with ALD and 1,452 with NAFLD) were studied, with a mean follow-up of 4.3 years for CVD and 4.7 years for mortality. Among those with ALD, NAFLD, or without liver disease hospital records 378, 320, and 21,873 CVD events; 268, 176, and 15,101 cancers; and 724, 221, and 16,203 deaths were reported, respectively. For ALD and NAFLD, respectively, adjusted HRs (95% CIs) compared with the group with no record of liver disease were 1.59 (1.43, 1.76) and 1.70 (1.52, 1.90) for CVD, 40.3 (28.8, 56.5) and 19.12 (11.71, 31.2) for hepatocellular carcinoma (HCC), 1.28 (1.12, 1.47) and 1.10 (0.94, 1.29) for non-HCC cancer, and 4.86 (4.50, 5.24) and 1.60 (1.40, 1.83) for all-cause mortality. CONCLUSIONS Hospital records of ALD or NAFLD are associated to varying degrees with an increased risk of CVD, cancer, and mortality among people with T2DM.
    Type of Medium: Online Resource
    ISSN: 0149-5992 , 1935-5548
    URL: Article
    DOI: 10.2337/dc17-1590
    Language: English
    Publisher: American Diabetes Association
    Publication Date: 2018
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  • 2
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    Association Between SGLT2 Inhibitor Treatment and Diabetic Ketoacidosis and Mortality in People With Type 2 Diabetes Admitted to Hospital With COVID-19
    American Diabetes Association ; 2022
    In:  Diabetes Care Vol. 45, No. 12 ( 2022-12-01), p. 2838-2843
    Details
    In: Diabetes Care, American Diabetes Association, Vol. 45, No. 12 ( 2022-12-01), p. 2838-2843
    Abstract: To determine the association between prescription of SGLT2 inhibitors (SGLT2is) and diabetic ketoacidosis (DKA) incidence or mortality in people with type 2 diabetes (T2D) hospitalized with COVID-19. RESEARCH DESIGN AND METHODS This was a retrospective cohort study based on secondary analysis of data from a large nationwide audit from a network of 40 centers in the U.K. with data collection up to December 2020. The study was originally designed to describe risk factors associated with adverse outcomes among people with diabetes who were admitted to hospital with COVID-19. The primary outcome for this analysis was DKA on or during hospital admission. The secondary outcome was mortality. Crude, age-sex adjusted, and multivariable logistic regression models were used to generate odds ratios (ORs) and 95% CIs for people prescribed SGLT2i compared with those not prescribed SGLT2i. RESULTS The original national audit included 3,067 people with T2D who were admitted to hospital with COVID-19, of whom 230 (7.5%) were prescribed SGLT2is prior to hospital admission. The mean age of the overall cohort was 72 years, 62.3% were men, and 34.9% were prescribed insulin. Overall, 2.8% of the total population had DKA and 35.6% of people in the study died. The adjusted odds of DKA were not significantly different between those prescribed SGLT2is and those not (OR 0.56; 95% CI 0.16–1.97). The adjusted odds of mortality associated with SGLT2is were similar in the total study population (OR 1.13; 95% CI 0.78–1.63), in the subgroup prescribed insulin (OR 1.02; 95% CI 0.59–1.77), and in the subgroup that developed DKA (OR 0.21; 95% CI 0.01–8.76). CONCLUSIONS We demonstrate a low risk of DKA and high mortality rate in people with T2D admitted to hospital with COVID-19 and limited power, but no evidence, of increased risk of DKA or in-hospital mortality associated with prescription of SGLT2is.
    Type of Medium: Online Resource
    ISSN: 0149-5992 , 1935-5548
    URL: Article
    DOI: 10.2337/dc22-0357
    Language: English
    Publisher: American Diabetes Association
    Publication Date: 2022
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  • 3
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    Performance of Cardiovascular Disease Risk Scores in People Diagnosed With Type 2 Diabetes: External Validation Using Data From the National Scottish Diabetes Register
    American Diabetes Association ; 2018
    In:  Diabetes Care Vol. 41, No. 9 ( 2018-09-01), p. 2010-2018
    Details
    In: Diabetes Care, American Diabetes Association, Vol. 41, No. 9 ( 2018-09-01), p. 2010-2018
    Abstract: To evaluate the performance of five cardiovascular disease (CVD) risk scores developed in diabetes populations and compare their performance to QRISK2. RESEARCH DESIGN AND METHODS A cohort of people diagnosed with type 2 diabetes between 2004 and 2016 was identified from the Scottish national diabetes register. CVD events were identified using linked hospital and death records. Five-year risk of CVD was estimated using each of QRISK2, ADVANCE (Action in Diabetes and Vascular disease: preterAx and diamicroN-MR Controlled Evaluation), Cardiovascular Health Study (CHS), New Zealand Diabetes Cohort Study (NZ DCS), Fremantle Diabetes Study, and Swedish National Diabetes Register (NDR) risk scores. Discrimination and calibration were assessed using the Harrell C statistic and calibration plots, respectively. RESULTS The external validation cohort consisted of 181,399 people with type 2 diabetes and no history of CVD. There were 14,081 incident CVD events within 5 years of follow-up. The 5-year observed risk of CVD was 9.7% (95% CI 9.6, 9.9). C statistics varied between 0.66 and 0.67 for all risk scores. QRISK2 overestimated risk, classifying 87% to be at high risk for developing CVD within 5 years; ADVANCE underestimated risk, and the Swedish NDR risk score calibrated well to observed risk. CONCLUSIONS None of the risk scores performed well among people with newly diagnosed type 2 diabetes. Using these risk scores to predict 5-year CVD risk in this population may not be appropriate.
    Type of Medium: Online Resource
    ISSN: 0149-5992 , 1935-5548
    URL: Article
    DOI: 10.2337/dc18-0578
    Language: English
    Publisher: American Diabetes Association
    Publication Date: 2018
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  • 4
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    Rising Rates and Widening Socioeconomic Disparities in Diabetic Ketoacidosis in Type 1 Diabetes in Scotland: A Nationwide Retrospective Cohort Observational Study
    American Diabetes Association ; 2021
    In:  Diabetes Care Vol. 44, No. 9 ( 2021-09-01), p. 2010-2017
    Details
    In: Diabetes Care, American Diabetes Association, Vol. 44, No. 9 ( 2021-09-01), p. 2010-2017
    Abstract: Whether advances in the management of type 1 diabetes are reducing rates of diabetic ketoacidosis (DKA) is unclear. We investigated time trends in DKA rates in a national cohort of individuals with type 1 diabetes monitored for 14 years, overall and by socioeconomic characteristics. RESEARCH DESIGN AND METHODS All individuals in Scotland with type 1 diabetes who were alive and at least 1 year old between 1 January 2004 and 31 December 2018 were identified using the national register (N = 37,939). DKA deaths and hospital admissions were obtained through linkage to Scottish national death and morbidity records. Bayesian regression was used to test for DKA time trends and association with risk markers, including socioeconomic deprivation. RESULTS There were 30,427 DKA admissions and 472 DKA deaths observed over 393,223 person-years at risk. DKA event rates increased over the study period (incidence rate ratio [IRR] per year 1.058 [95% credibility interval 1.054–1.061] ). Males had lower rates than females (IRR male-to-female 0.814 [0.776–0.855]). DKA incidence rose in all age-groups other than 10- to 19-year-olds, in whom rates were the highest, but fell over the study. There was a large socioeconomic differential (IRR least-to-most deprived quintile 0.446 [0.406–0.490] ), which increased during follow-up. Insulin pump use or completion of structured education were associated with lower DKA rates, and antidepressant and methadone prescription were associated with higher DKA rates. CONCLUSIONS DKA incidence has risen since 2004, except in 10- to 19-year-olds. Of particular concern are the strong and widening socioeconomic disparities in DKA outcomes. Efforts to prevent DKA, especially in vulnerable groups, require strengthening.
    Type of Medium: Online Resource
    ISSN: 0149-5992 , 1935-5548
    URL: Article
    DOI: 10.2337/dc21-0689
    Language: English
    Publisher: American Diabetes Association
    Publication Date: 2021
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  • 5
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    Fatty Liver, Insulin Resistance, and Features of Metabolic Syndrome
    American Diabetes Association ; 2012
    In:  Diabetes Care Vol. 35, No. 11 ( 2012-11-01), p. 2359-2364
    Details
    In: Diabetes Care, American Diabetes Association, Vol. 35, No. 11 ( 2012-11-01), p. 2359-2364
    Abstract: Nonalcoholic fatty liver disease (NAFLD) coexists with insulin resistance (IR), but it is uncertain whether NAFLD and IR contribute independently to atherosclerosis. We tested whether fatty liver, IR, and metabolic syndrome (MetS) features (waist, glucose, triglyceride, HDL cholesterol [HDL-C], and blood pressure) were associated with a marker of atherosclerosis (coronary artery calcium [CAC] score & gt;0), independently of cardiovascular risk factors and cardiovascular disease (CVD). RESEARCH DESIGN AND METHODS Data were analyzed from a South Korean occupational cohort of 10,153 people who all received ultrasound measurements of fatty liver and a cardiac computed tomography CAC score. IR was defined by homeostasis model assessment of IR (HOMA-IR) ≥75th percentile. Odds ratios (ORs) (95% CIs) for the presence of a CAC score & gt;0 were estimated using logistic regression. RESULTS There were 915 people with a CAC score & gt;0. MetS features were increased (glucose, blood pressure, triglyceride, and waist) or decreased (HDL-C) among people with a CAC score & gt;0 (all comparisons against CAC score ≤0; P & lt; 0.0001). Of subjects with a CAC score & gt;0, 55% had fatty liver and 33.7% were insulin resistant. Fatty liver (OR 1.21 [95% CI 1.01–1.45]; P = 0.04) and HOMA-IR (1.10 [1.02–1.18] ; P = 0.02) were associated with CAC score & gt;0, independently of all MetS features, conventional cardiovascular risk factors, and prior evidence of CVD. The presence of IR and fatty liver combined was associated with CAC score & gt;0 (1.53 [1.20–1.95]; P = 0.001). CONCLUSIONS Fatty liver and HOMA-IR are both associated with a CAC score & gt;0 (independently of each other), features of MetS, conventional cardiovascular risk factors, and existing CVD.
    Type of Medium: Online Resource
    ISSN: 0149-5992 , 1935-5548
    URL: Article
    DOI: 10.2337/dc12-0515
    Language: English
    Publisher: American Diabetes Association
    Publication Date: 2012
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  • 6
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    Relation of Incident Type 1 Diabetes to Recent COVID-19 Infection: Cohort Study Using e-Health Record Linkage in Scotland
    American Diabetes Association ; 2023
    In:  Diabetes Care Vol. 46, No. 5 ( 2023-05-01), p. 921-928
    Details
    In: Diabetes Care, American Diabetes Association, Vol. 46, No. 5 ( 2023-05-01), p. 921-928
    Abstract: Studies using claims databases reported that severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection & gt;30 days earlier was associated with an increase in the incidence of type 1 diabetes. Using exact dates of diabetes diagnosis from the national register in Scotland linked to virology laboratory data, we sought to replicate this finding. RESEARCH DESIGN AND METHODS A cohort of 1,849,411 individuals aged & lt;35 years without diabetes, including all those in Scotland who subsequently tested positive for SARS-CoV-2, was followed from 1 March 2020 to 22 November 2021. Incident type 1 diabetes was ascertained from the national registry. Using Cox regression, we tested the association of time-updated infection with incident diabetes. Trends in incidence of type 1 diabetes in the population from 2015 through 2021 were also estimated in a generalized additive model. RESULTS There were 365,080 individuals who had at least one detected SARS-CoV-2 infection during follow-up and 1,074 who developed type 1 diabetes. The rate ratio for incident type 1 diabetes associated with first positive test for SARS-CoV-2 (reference category: no previous infection) was 0.86 (95% CI 0.62, 1.21) for infection & gt;30 days earlier and 2.62 (95% CI 1.81, 3.78) for infection in the previous 30 days. However, negative and positive SARS-CoV-2 tests were more frequent in the days surrounding diabetes presentation. In those aged 0–14 years, incidence of type 1 diabetes during 2020–2021 was 20% higher than the 7-year average. CONCLUSIONS Type 1 diabetes incidence in children increased during the pandemic. However, the cohort analysis suggests that SARS-CoV-2 infection itself was not the cause of this increase.
    Type of Medium: Online Resource
    ISSN: 0149-5992 , 1935-5548
    URL: Article
    DOI: 10.2337/dc22-0385
    Language: English
    Publisher: American Diabetes Association
    Publication Date: 2023
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  • 7
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    Global Prevalence of Diabetes: Estimates for the Year 2000 and Projections for 2030
    American Diabetes Association ; 2004
    In:  Diabetes Care Vol. 27, No. 10 ( 2004-10-01), p. 2569-2569
    Details
    In: Diabetes Care, American Diabetes Association, Vol. 27, No. 10 ( 2004-10-01), p. 2569-2569
    Type of Medium: Online Resource
    ISSN: 0149-5992 , 1935-5548
    URL: Article
    DOI: 10.2337/diacare.27.10.2569-a
    Language: English
    Publisher: American Diabetes Association
    Publication Date: 2004
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  • 8
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    Severe Mental Illness and Type 2 Diabetes Outcomes and Complications: A Nationwide Cohort Study
    American Diabetes Association ; 2023
    In:  Diabetes Care Vol. 46, No. 7 ( 2023-07-01), p. 1363-1371
    Details
    In: Diabetes Care, American Diabetes Association, Vol. 46, No. 7 ( 2023-07-01), p. 1363-1371
    Abstract: To compare cardiovascular and mortality outcomes in people with severe mental illness (SMI) versus no mental illness in a national cohort study of people with type 2 diabetes. RESEARCH DESIGN AND METHODS We included adults diagnosed with type 2 diabetes between 2004 and 2018 from the national Scottish diabetes register, ascertaining history of mental illness from linked psychiatric and general hospital admission records. We identified major cardiovascular disease (CVD) events, all-cause mortality, and CVD-specific mortality through record linkage. Using Cox regression, we estimated hazard ratios (HRs) for associations between SMI and outcomes, adjusting for baseline sociodemographic and clinical characteristics, including history of CVD, comorbidity, hypertension, high cholesterol, HbA1c, BMI, alcohol use disorder, and smoking. RESULTS Among 259,875 people with type 2 diabetes, 1.0%, 0.5%, and 3.0% had schizophrenia, bipolar disorder, and major depression, respectively. After adjusting for sociodemographic characteristics, the risk of major CVD events was higher in people with schizophrenia (HR 1.22, 95% CI 1.06–1.41), bipolar disorder (HR 1.58, 95% CI 1.33–1.87), and major depression (HR 1.59, 95% CI 1.49–1.70) compared with people without a history of mental illness. SMI was also associated with an approximately twofold increased risk of CVD-specific and all-cause mortality. All associations attenuated following further adjustment for clinical characteristics. CONCLUSIONS Among people with diabetes, people with a history of SMI have poorer cardiovascular and mortality outcomes compared with those without mental illness. While the underlying mechanisms are further investigated, effective prevention and management of cardiovascular risk factors is needed in this high-risk group.
    Type of Medium: Online Resource
    ISSN: 0149-5992 , 1935-5548
    URL: Article
    DOI: 10.2337/dc23-0177
    Language: English
    Publisher: American Diabetes Association
    Publication Date: 2023
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  • 9
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    Cardiovascular Safety in Type 2 Diabetes With Sulfonylureas as Second-line Drugs: A Nationwide Population-Based Comparative Safety Study
    American Diabetes Association ; 2023
    In:  Diabetes Care Vol. 46, No. 5 ( 2023-05-01), p. 967-977
    Details
    In: Diabetes Care, American Diabetes Association, Vol. 46, No. 5 ( 2023-05-01), p. 967-977
    Abstract: To assess the real-world cardiovascular (CV) safety for sulfonylureas (SU), in comparison with dipeptidyl peptidase 4 inhibitors (DPP4i) and thiazolidinediones (TZD), through development of robust methodology for causal inference in a whole nation study. RESEARCH DESIGN AND METHODS A cohort study was performed including people with type 2 diabetes diagnosed in Scotland before 31 December 2017, who failed to reach HbA1c 48 mmol/mol despite metformin monotherapy and initiated second-line pharmacotherapy (SU/DPP4i/TZD) on or after 1 January 2010. The primary outcome was composite major adverse cardiovascular events (MACE), including hospitalization for myocardial infarction, ischemic stroke, heart failure, and CV death. Secondary outcomes were each individual end point and all-cause death. Multivariable Cox proportional hazards regression and an instrumental variable (IV) approach were used to control confounding in a similar way to the randomization process in a randomized control trial. RESULTS Comparing SU to non-SU (DPP4i/TZD), the hazard ratio (HR) for MACE was 1.00 (95% CI: 0.91–1.09) from the multivariable Cox regression and 1.02 (0.91–1.13) and 1.03 (0.91–1.16) using two different IVs. For all-cause death, the HR from Cox regression and the two IV analyses was 1.03 (0.94–1.13), 1.04 (0.93–1.17), and 1.03 (0.90–1.17). CONCLUSIONS Our findings contribute to the understanding that second-line SU for glucose lowering are unlikely to increase CV risk or all-cause mortality. Given their potent efficacy, microvascular benefits, cost effectiveness, and widespread use, this study supports that SU should remain a part of the global diabetes treatment portfolio.
    Type of Medium: Online Resource
    ISSN: 0149-5992 , 1935-5548
    URL: Article
    DOI: 10.2337/dc22-1238
    Language: English
    Publisher: American Diabetes Association
    Publication Date: 2023
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  • 10
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    Low Ankle-Brachial Pressure Index Predicts Increased Risk of Cardiovascular Disease Independent of the Metabolic Syndrome and Conventional Cardiovascular Risk Factors in the Edinburgh Artery Study
    American Diabetes Association ; 2006
    In:  Diabetes Care Vol. 29, No. 3 ( 2006-03-01), p. 637-642
    Details
    In: Diabetes Care, American Diabetes Association, Vol. 29, No. 3 ( 2006-03-01), p. 637-642
    Abstract: OBJECTIVE—To investigate whether a low ankle-brachial pressure index (ABI) predicts increased risk of cardiovascular disease (CVD) independent of the metabolic syndrome and conventional cardiovascular risk factors. RESEARCH DESIGN AND METHODS—The Edinburgh Artery Study is a population-based cohort study in which subjects were followed up until their death or for ∼15 years. Low ABI at baseline was defined as & lt;0.9; subjects with ABI & gt;1.4 (n = 13) were excluded from the analyses. We used a modified version of the definition of the metabolic syndrome published in the Third Report of the National Cholesterol Education Program Expert Panel on Detection, Evaluation, and Treatment of High Blood Cholesterol in Adults, replacing waist circumference criteria with BMI criteria. Data on relevant parameters were available for 1,467 men and women ages 55–74 years at baseline. Cox proportional hazards models were used to study cardiovascular morbidity and mortality before and after adjusting for potential confounding factors. RESULTS—We determined that 25% of the study population had the metabolic syndrome and that a low ABI was more prevalent among people with than without the metabolic syndrome (24 vs. 15%; P & lt; 0.001). During the follow-up period, there were 226 deaths from CVD and 462 nonfatal cardiovascular events. The hazard ratio (95% CI) for low ABI after adjusting for age, sex, baseline CVD, diabetes, smoking status, LDL cholesterol, and metabolic syndrome was 1.5 (1.1–2.1) for CVD mortality and 1.5 (1.2–1.8) for all CVD outcomes. CONCLUSIONS—Low ABI is associated with increased risk of CVD independent of the metabolic syndrome and other major CVD risk factors.
    Type of Medium: Online Resource
    ISSN: 0149-5992 , 1935-5548
    URL: Article
    DOI: 10.2337/diacare.29.03.06.dc05-1637
    Language: English
    Publisher: American Diabetes Association
    Publication Date: 2006
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